Monday, October 24, 3:00 p.m.-4:30
p.m.
Medicare Health Support: An Innovation in Prevention for
Chronically Ill Medicare Beneficiaries
Authors
S.M. Foote1; R.A. Kahn2; W.J. Katon3;
J.S. Wright4.
1Centers for Medicare & Medicaid Services, Baltimore, MD;
2American Diabetes Association, Alexandria, VA;
3University of Washington, Seattle, WA;
4American College of Cardiology, Bethesda, MD.
Background
Medicare fee-for-service beneficiaries with diabetes mellitus
(DM) and/or congestive heart failure (CHF) are large and costly
subpopulations. Approximately 14% of beneficiaries have CHF, 18%
have DM. They account for 43% and 32% of Medicare spending
respectively (including co-morbidities such as depression).
Multiple studies have documented suboptimal care among
individuals with these conditions. Some research suggests that
population-based disease management (PDM) programs may improve
quality and reduce costs for these patients. Section 721 of the
2003 Medicare Drug Prescription, Improvement and Modernization
Act authorizes the Centers for Medicare & Medicaid Services
(CMS) to develop and test voluntary chronic care improvement
programs, using PDM techniques, for selected subpopulations of
chronically ill Medicare beneficiaries. Medicare Health Support
(MHS) pilot programs are now being implemented in several
regions in response to this legislative mandate.
Methods
For each regional MHS pilot program, approximately
30,000 fee-for-service Medicare beneficiaries who have DM, CHF,
or both, and who are at higher than average risk of
complications, have been identified through claims data. Among
them, 20,000 have been randomly selected to participate in MHS
if they so choose. The remaining 10,000 beneficiaries will serve
as a comparison group. Each MHS program will be run by an
organization that was competitively selected by CMS. The
cooperative agreements between CMS and these organizations
stipulate that the organizations will be paid a fee per
participant per month. The fees will be at risk for achievement
of agreed-upon performance guarantees for improvement in
participant satisfaction, clinical quality, and savings to
Medicare across the entire population of 20,000 targeted
beneficiaries compared to the control group over three years.
Results
Nine pilot programs have been awarded. Most will be
operational by October 2005.
Discussion
The medical literature suggests the MHS initiative
may have profound effects, preventing debilitating and costly
complications in the targeted subpopulations.
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Implementing Diverse National Strategies To Address Health
Promotion in Older Adults
Authors
J.E. Lang1; D. Lawry2; L. Anderson1.
1Centers for Disease Control and Prevention (CDC),
Atlanta, GA;
2Administration on Aging, Washington, DC.
Background
Several examples involving multiple national, state, and local
partners spearheaded by the Centers for Disease Control and
Prevention (CDC) and the Administration on Aging (AoA) have
been implemented since 2001 to address the health needs of
older adults. This session highlights two examples of grants
programs targeting older adults. Each program seeks to reach
older adults where they live and congregate. CDC and AoA are
utilizing their respective networks including state and local
health departments, state units on aging, and area agencies on
aging to implement programs at the local level. Each state or
local entity has partnered with community organizations, local
providers, academic institutions, or non profit groups to
enhance capacity and contribute expertise in program
evaluation, implementation, and outreach. Activities have
taken place at senior centers, in minority neighborhoods,
Indian reservations, and faith-based institutions.
Methods
The presenters will share goals, objectives,
interventions, and outcomes for 1) the National Evidence-based
Disease Prevention Grants program; and 2) the SENIOR grants
program. Each program emphasizes partnership and the use of
evidence-based approaches in the areas of physical activity,
chronic disease self management, and the increased use of
clinical preventive services.
Results
Each program has been successful in recruiting and
developing partnerships at the state and local level which has
enhanced the success of program development, marketing, and
implementation. Culturally appropriate approaches to health
promotion for older adults has increased enrollment among
racial/ethnic minority older adults.
Discussion
These examples demonstrate creative strategies to
reach older adults, diverse partners who bring specialized
expertise to the projects, and strategies for addressing the
unique needs of older adults. The partnerships developed
through the course of each program are critical to bringing
the respective expertise and strengths of the public health
and aging services networks together to comprehensively
address older adult health.
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Where's Wilmarth Walking? Proven Program Finds Hero
Authors
M. McFadden1; P. Fell2.
1Broome County Health Department, Binghamton, NY;
2UHS Hospitals, Johnson City, NY.
Background
Physical inactivity and age are major risk factors
in the development of chronic disease. Less than 25% of Broome
County residents engage in some type of regular physical
activity. This coupled with 20% of the Broome County
population aged 60 years or older, ranks Broome County higher
than the upstate New York average for chronic disease rates.
Methods
The evidenced based, BC Walks program promotes
walking as one of the best forms of physical activity,
especially for the aging residents of Broome County. Using a
large multi media and health promotion campaign, BC Walks
provides a simple message: Starting with just 10 minutes a
day, and working up to 30 minutes of moderate walking most
days of the week, can help prevent chronic diseases. The BC
Steps program expanded BC Walks into worksites, schools, faith
based organizations and health care institutions to reach
priority populations such as seniors, and engage 70,000 of
200,000 Broome County residents in regular physical activity.
BC Walks combines walking logs and pedometer incentives to
create lifelong habits.
Results
Alan Wilmarth; a 50 year old hospital administrator,
joined BC Walks as part of a worksite initiative, lost 60
pounds, cut his cholesterol medicine in half and stopped
taking blood pressure medication. Using social marketing
principals to highlight this hero, the "Where's Wilmarth
Walking" TV campaign was born. "Where's Wilmarth" showcases
volunteer Alan throughout Broome County (anywhere and in any
kind of weather) engaging in walking with different local
celebrities from Steps priority populations were they live,
work, worship and learn. According to the most recent Steps to
a HealthierNY Broome County BRFSS data, 67% of the respondents
stated they've heard of BC Walks and process measures indicate
BC walks enrollment is growing due to these media campaigns.
Discussion
Audience will capture evidenced based intervention
strategy to implement an effective community walking program
and Alan Wilmarth will provide a live testimonial.
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You Can! Steps to Healthier Aging
Authors
K.A. Loughrey1; N. Wellman2; J. Lloyd1;
L. Lindsey3.
1U.S. DHHS Administration on Aging, Washington, DC;
2Florida International University, Miami, FL;
3Valley Program for Aging Services, Waynesboro, VA.
Background
This presentation will highlight the results of the
You Can! Steps to Healthier Campaign and applied community-based
research for promoting healthier aging. The You Can! campaign is
sponsored by the U.S. Department of Health and Human Services
Administration on Aging (AoA) and is the aging component of the
Steps to a HealthierUS initiative. Kay Loughrey, AoA
Representative, will discuss the evidence that the campaign is
working. Her presentation will focus on how the campaign has
supported and engaged more than 2,600 partners; has used social
marketing research to focus the campaign on social engagement;
and will discuss the evidence for program and individual
outcomes based on the results community-based research involving
more than 900 older adults in a wide variety of settings.
Methods
Evidence of research showing positive outcomes of The
You Can! campaign will be shared.
Results
Campaign outcomes and community research will be
described. For example, the multi-site demonstration project
preliminary results indicated significant improvements in food
choices, physical activity, falls risk and behavior change.
Discussion
Policy implications will be explored in a discussion
of the outcomes for the campaign and the community research.
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